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How long should I be in therapy?

Dear Alice,

How long is psychotherapy supposed to take? I was in therapy for twelve years and felt much worse coming out of it than I did going in. My obsessive compulsive disorder remained unchanged, my socially avoidant behavior was the same, I was still depressed. In fact, I really think I felt worse because I was now angry at therapists. And yet the word on the street is that therapy really works, and I think it is supposed to take less than twelve years. Please answer me, I think this is an important question.

Dear Reader,

Your question is a significant one that many folks are qually concerned about. There is no one simple answer, as each individual's experience with and needs from therapy vary from person to person. Psychotherapy works for many people and is often the key to overcoming complex problems that are too overwhelming for people to handle on their own. The length and nature of psychotherapy varies from person to person, depending on a great number of factors. Twelve years seems like a long time to be in therapy, but it is not unheard of. People work on different issues and develop at different paces. And what you consider to be non-productive therapy need not be a reason to give up entirely, especially if none of your problems have been resolved, or if you even feel worse now.

It's not clear if your decision to end therapy was yours or your therapist's. If a person is dissatisfied with her/his therapy or therapist, it's best to bring this up for discussion in a therapy session. You might have talked about the length of your therapy program, your impression that the problems have remained the same, or even worse, that you had become angry on top of the issues that prompted you originally to seek therapy. A good therapist will welcome this kind of discussion with her/his patient and will not be angry or offended that s/he brings it up. Talking about your goals and expectations and how realistic they are is also appropriate and key.

Perhaps you can learn from your experience and search for a new therapist who can help you address the original issues (your obsessive-compulsive disorder, socially avoidant behavior, and depression). It is good, too, to bring up your current anger and distrust of therapists. Your health care provider may be able to give you a start. You might want to consult with two or three new therapists until you find one with whom you think you can make progress. People will often meet or even work with a few therapists before finding one with whom they feel comfortable. Therapy often involves a lot of one-on-one time. The personal interaction between a therapist and a patient is considerable, and building trust is a vital component of that interaction.

You point out that in addition to not making progress, you are angry at therapists. Anger can be constructive in therapy. If you are someone who is often angry, therapy might allow you to become angry with the therapist so that you can together analyze and understand the emotion. But if you continually get angry with the therapist and never seem to work through that anger, then treatment may not be working. It seems as though you are not only angry at therapists, but with the mental health profession in general, for failing to resolve the problems you presented, especially after such a significant time and perhaps financial commitment.

If psychotherapy doesn't seem to be helping after having discussed with your therapist the concerns mentioned above, you may want to explore other modes of therapy and/or ancillary treatment, such as trying new or changing medications, which might prove helpful. You could also seek out a "second opinion" with a senior clinician. While this is not common, it may be useful in your decision making, to help you evaluate how well your therapy is working.